Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children

Zheng, Zhiyuan; Zhao, Jingxuan; Nogueira, Letícia; Han, Xuesong; Fan, Qinjin; Yabroff, K. Robin

doi:10.1001/jamapediatrics.2022.0494

Cited by 11 publications

(13 citation statements)

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“…Moreover, non-Hispanic Black children, children whose parents had poor health, and children living in low-income families were more likely to experience food insecurity and parent’s financial worry about paying monthly bills and housing costs. Our findings add to the accumulating evidence that a cancer diagnosis can adversely affect physical and mental health and financial burden for other family members, including spouses and other informal caregivers . Our findings also suggest that efforts to identify children with a parental cancer history and screen for any unmet economic needs and connect them with relevant services are warranted.…”

Section: Discussionsupporting

confidence: 56%

“…Our findings add to the accumulating evidence that a cancer diagnosis can adversely affect physical and mental health and financial burden for other family members, including spouses and other informal caregivers. [14][15][16][17] Our findings also suggest that efforts to identify children with a parental cancer history and screen for any unmet economic needs and connect them with relevant services are warranted.…”

Section: Discussionmentioning

confidence: 77%

“…Previous research 14 on parental cancer history found worse physical and mental health outcomes among minor children. However, the potential pathways for these associations were unclear.…”

Section: Discussionmentioning

confidence: 84%

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Parental Cancer History and Its Association With Minor Children’s Unmet Food, Housing, and Transportation Economic Needs

et al. 2023

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ImportanceA cancer diagnosis is associated with substantial economic burden for patients and their families. Young adult cancer survivors with dependent children may be particularly vulnerable to financial hardship.ObjectiveTo examine associations of parental cancer with their children’s unmet economic needs.Design, Setting, and ParticipantsThis cross-sectional study used data from the nationally representative 2013 to 2018 US National Health Interview Survey. Children aged 5 to 17 years living in families with and without parental cancer history were queried about recent 1-year experiences. Statistical analyses were conducted from January 2022 to April 2023.ExposureParental cancer history.Main Outcomes and MeasuresThe main outcomes were children’s unmet economic needs, including family-level food insecurity, parent’s financial worry about paying for monthly bills and housing costs, and delayed child medical care owing to lack of transportation. Multivariable logistic regressions adjusted for (1) child’s characteristics (ie, age group, sex, and race and ethnicity), (2) parent’s characteristics (ie, age group, sex, health insurance coverage, comorbid conditions, and obesity status), and (3) family’s characteristics (ie, family structure [married or cohabiting parents vs single parent families], highest educational attainment in the family, and family income). Additional analyses focused on children with a parental cancer history to identify potentially modifiable characteristics associated with unmet economic needs.ResultsIn this cross-sectional study of 22 941 children with (812 children; weighted number, 860 488 children) and without (22 129 children; weighted number, 24 545 463 children) a parental cancer history, the majority of children were aged 5 to 11 years (12 022 children [52.4%]), male (11 920 children [52.0%]), and non-Hispanic White (11 863 children [51.7%]). In adjusted analyses, parental cancer history was associated with more severe family-level food insecurity, including worrying about food running out (odds ratio [OR], 1.97; 95% CI, 1.56-2.49; P &lt; .001), food not lasting (OR, 2.01; 95% CI, 1.56-2.58; P &lt; .001), and inability to afford balanced meals (OR, 1.38; 95% CI, 1.06-1.79; P = .02). Moreover, parental cancer history was associated with parent’s worry about paying monthly bills (OR, 1.41; 95% CI, 1.15-1.74; P = .001) and housing-related costs (OR, 1.31; 95% CI, 1.07-1.60; P = .009) and delays in child medical care because of lack of transportation (OR, 2.31; 95% CI, 1.49-3.59; P &lt; .001). Among children with parental cancer history, female children, non-Hispanic Black children, children whose parents had multiple comorbidities, and children living in low-income families were especially vulnerable to unmet economic needs.Conclusions and RelevanceParental cancer is associated with greater likelihood of food insecurity, unaffordability of housing and other necessities, and transportation barriers to medical care for minor children. Strategies to identify such children and address their needs are warranted.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 77%

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Parental Cancer History and Its Association With Minor Children’s Unmet Food, Housing, and Transportation Economic Needs

et al. 2023

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“…Drawing on data from the 2010 to 2018 National Health Interview Survey, they found that when parents of minors experience cancer, children were more likely to miss school, miss well-child checkups, visit emergency departments, and experience negative mental health consequences. 11 In part, these findings make intuitive sense. Witnessing firsthand a loved one experience a life-threatening illness and potentially watching them suffer is inherently upsetting, stressful, even personally threatening.…”

mentioning

confidence: 91%

“…In this issue, Zheng and colleagues further our knowledge about this problem, spelling out this disruption in greater detail. Drawing on data from the 2010 to 2018 National Health Interview Survey, they found that when parents of minors experience cancer, children were more likely to miss school, miss well-child checkups, visit emergency departments, and experience negative mental health consequences …”

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confidence: 98%

Illness in the Family and Shared Stress, Work, and Struggle

2022

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Medical practice for much of the past century has tended to treat patients as though they existed in isolation, focusing on their individual clinical problems. While pediatrics has always underscored the importance of partnering with parents in the care of their children and family medicine considered patients as part of a family system, much of medical care proceeds as though blithely unaware of the collateral impact of the patients' illness on the health of other family members.This collateral impact is important. Pediatric illness has been shown to have profound effects on parental well-being. 1 When children experience a serious illness, families struggle financially, 2 parents and siblings experience distress, 3-5 and parents and siblings use more health care services. 6 The converse is also true. For example, we know from prior research that parental cancer disrupts the lives of their families, including their children. 7,8 And for several decades we have known of the negative consequences on wives or husbands of having a spouse with a serious illness. 9,10 Consistently, these lines of research show that when any member of a family experiences a serious illness, the other family members experience immediate and long-term negative consequences.In this issue, Zheng and colleagues 11 further our knowledge about this problem, spelling out this disruption in greater detail. Drawing on data from the 2010 to 2018 National Health Interview Survey, they found that when parents of minors experience cancer, children were more likely to miss school, miss well-child checkups, visit emergency departments, and experience negative mental health consequences. 11 In part, these findings make intuitive sense. Witnessing firsthand a loved one experience a life-threatening illness and potentially watching them suffer is inherently upsetting, stressful, even personally threatening. No one wants to experience pain, shortness of breath, disability, or delirium, and no one wants to see any of this happening to a family member. Having to grapple with the possibility of the loved one's death in the near future, or far earlier than previously imagined, is distressing. These challenges can be especially troubling for young children to witness, as they may not be able to process or understand the full implication of the diagnosis either because they are cognitively incapable of doing so or because their parents do not share with them, in a developmentally appropriate context, the medical details of their struggle.But beyond these psychological and stress-related explanations, 2 other factors quite likely are also important parts of the mechanism by which having an ill family member, either a child or an adult, is deleterious to other family members. First, the plain work of caring for a seriously ill family member at

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Health‐related social needs, medical financial hardship, and mortality risk among cancer survivors

Zheng,

Hu,

Banegas

et al. 2024

Cancer

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BackgroundCancer survivors may face challenges affording food, housing, and other living necessities, which are known as health‐related social needs (HRSNs). However, little is known about the associations of HRSNs and mortality risk among adult cancer survivors.MethodsAdult cancer survivors were identified from the 2013–2018 National Health Interview Survey (NHIS) and linked with the NHIS Mortality File with vital status through December 31, 2019. HRSNs, measured by food insecurity, and nonmedical financial worries (e.g., housing costs), was categorized as severe, moderate, and minor/none. Medical financial hardship, including material, psychological, and behavioral domains, was categorized as 2‐3, 1, or 0 domains. Using age as the time scale, the associations of HRSNs and medical financial hardship and mortality risk were assessed with weighted adjusted Cox proportional hazards models.ResultsAmong cancer survivors 18–64 years old (n = 5855), 25.5% and 18.3% reported moderate and severe levels of HRSNs, respectively; among survivors 65–79 years old (n = 5918), 15.6% and 6.6% reported moderate and severe levels of HRSNs, respectively. Among cancer survivors 18–64 years old, severe HRSNs was associated with increased mortality risk (hazards ratio [HR], 2.00; 95% confidence interval [CI], 1.36–2.93, p < .001; reference = minor/none) in adjusted analyses. Among cancer survivors 65–79 years old, 2‐3 domains of medical financial hardship was associated with increased mortality risk (HR, 1.58; 95% CI, 1.13–2.20, p = .007; reference = 0 domain).ConclusionsHSRNs and financial hardship are associated with increased mortality risk among cancer survivors; comprehensive assessment of HRSN and financial hardship connecting patients with relevant services can inform efforts to mitigate adverse consequences of cancer.

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Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children

Cited by 11 publications

References 37 publications

Parental Cancer History and Its Association With Minor Children’s Unmet Food, Housing, and Transportation Economic Needs

Parental Cancer History and Its Association With Minor Children’s Unmet Food, Housing, and Transportation Economic Needs

Illness in the Family and Shared Stress, Work, and Struggle

Health‐related social needs, medical financial hardship, and mortality risk among cancer survivors

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